Use of donors at age extremes for simultaneous pancreas-kidney transplant

Abstract

Type 1 diabetes mellitus (T1DM) is a major cause of morbidity and mortality in the United States and accounts for about 245 billion annual health-care costs. [1][2][3][4] There are 1.25 million Americans are living with T1DM, 85% of who are adults, with 40, 000 new diagnoses each year, and an estimated 5 million people with T1DM in the U. S. by 2050. [3][4][5][6][7] Simultaneous pancreas-kidney transplant (SPKT) is a well-established treatment for patients with T1DM complicated by end-stage renal disease. [8][9][10][11][12][13] Despite an increase in the number of deceased donor pancreata recovered over the last decade, the overall number of pancreas transplants has continued to decline. [14,15] This is, in part, due to historically poor outcomes from pancreas transplant. The recent implementation of a new pancreas allocation system, along with the proposal for a consistent definition of pancreas graft failure, as well as improving outcomes (graft and patient survival), is expected to improve the overall rates of SPKT being performed. [16,17] Unfortunately, the number of diabetic patients on the pancreas transplant waiting list continues to rise and exceeds the number of available donor organs. [16,18] This mandates different options to expand the donor pool while maintaining excellent outcome.Conventionally, pediatric donors (PDs) have been underutilized for SPKT. This was mostly driven by the lack of standard criteria for an acceptable pancreas graft. [19,20] PDs are considered by most centers to be marginal grafts due to perceived lower islet mass, higher technical demand, and potential complications. [21][22][23] Older donors (ODs) are equally also underutilized due to a perceived shorter graft survival and less optimal function. [16,24] However, there is growing evidence from single-center studies that these organs may provide comparable outcomes to standard age donors. [19,23,[25][26][27][28][29] Nevertheless, there remains a paucity of the literature to encourage the use of these donors, and as such, many centers Introduction: There is a shortage of optimal pancreatic donors for simultaneous pancreas and kidney transplant (SPKT), as such there is interest in utilizing donors at extremes of age to expand the donor pool. We sought to evaluate outcomes in SPKT from pediatric donors (PDs) to older donors (ODs). Patients and Methods: We identified patients who underwent simultaneous pancreas and kidney transplant at a single, high-volume institution from 1988-2013. We evaluated for differences in transplant organ function (estimated glomerular filtration rate [GFR], serum glucose, and urine amylase), early (technical) graft loss, and patient and graft survival. Results: A total of 729 SPKT were performed during the study, with 32 PDs, 652 standard donors (SDs), and 45 ODs. Renal function was slightly worse in OD. Otherwise, graft function was similar between all three groups at up to 5 years. There was no difference in censored survival analyses for both kidney and pancreas allografts. There was comparable sho...

Solid pancreas transplant outcomes with increased donor and recipient ages compared with reference ages: a systematic review

“…Although the age threshold by which older and reference-aged pancreas donors are commonly defined ranges 45À50 years (less commonly defined in pancreas transplant recipients), other studies have analysed a range of donor and recipient age thresholds for associations with solid pancreas transplant outcomes, which did not meet inclusion criteria for our review. Among such studies were eight studies comparing outcomes in groups differentiated by recipient upper age limits ranging 45À60 years, 9,34,[38][39][40][41][42][43] six studies comparing outcomes in groups differentiated by donor upper age limits ranging 40À50 years 7,[44][45][46][47][48] and two studies comparing outcomes in donor-recipient age-matched groups. 49,50 Of these, seven of eight studies comparing outcomes by recipient age showed no significant difference in primary outcomes between groups (Supporting Information Table S5).…”